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Provisional Postpartum Care Extension
The following PPCE guidance ended on March 31, 2022 and has been replaced with ARPA 365-day PCE.
Under Senate Bill (SB) 104, the Provisional Postpartum Care Extension (PPCE) allows an individual who would lose MC or Medi-Cal Access Program (MCAP) coverage after the 60-day postpartum period to remain eligible under their current aid category for an additional 10 months if they have been diagnosed with a maternal mental health condition. This program began August 1, 2020 and is scheduled to end December 31, 2021 unless it is extended by the Legislature.
In order for eligibility to be extended, an individual must provide a Medical Report for Medi-Cal or MCAP Postpartum Care Extension form (MC 61 PPCE) which has been signed by a treating health care provider indicating that the individual has been diagnosed with a maternal mental health condition during their pregnancy, postpartum or 90-day cure period following the postpartum period. The completed form can be submitted during any of these periods. The individual will not be placed into a PPCE aid code (M7, M8, M9, M0, or 0E for MCAP) until the end of the 60-day postpartum period. The 10 months of PPCE eligibility are granted retroactively to begin where the postpartum period ended.
PPCE Informing
EW must send the MC 61 PPCE and PPCE Flyer any time client requests and at one of the following intervals:
- Report of a pregnancy
- Report of the end of pregnancy
- Report of a birth
Important: EW must case comment to indicate that the MC 61 PPCE and PPCE Flyer have been sent.
Granting PPCE Eligibility
Once completed MC 61 PPCE is received, the EW will grant PPCE at the end of 60-day postpartum period by completing an override in CalSAWS and submitting a corresponding SCD 1296 for MEDS. The SCD 1296 must have the begin and end dates for the 10 month PPCE period as well as termination code “41” - PPCE eligibility ending. The MTO will enter this as a closed period exception eligible transaction (ESAC 9). The MC 239 V will be used as the approval NOA.
SCD 1296 exampleSCD 1296 example
MEDS alerts 9561 and 9562 will generate when PPCE is ending or overdue and eligibility needs to be redetermined. The end of the PPCE period will be treated as a change in circumstance (CIC) and the PPCE individual must have their eligibility redetermined. Annual redeterminations (RDs) which are due during the PPCE period must not negatively affect PPCE eligibility.
Note: MCAP individuals (aid code 0E) will have their PPCE administered by MAXIMUS. If an EW receives the MC 61 PPCE for an individual in aid code 0E, they shall send the scanned copy to MAXIMUS by secure email at SPELiaisons@maximus.com.
Postpartum Care Extension to 365 Days
Prior to April 1, 2022, a pregnant individual eligible for Medi-Cal during the last month of pregnancy continued eligibility for all pregnancy-related and postpartum services for a 60-day period beginning on the last day of pregnancy. Access to these services ended on the last day of the month in which the 60-day period ends. Under the provisions of the American Rescue Plan Act (ARPA), beginning April 1, 2022, California opted to extend the Medi-Cal postpartum period to a 365-day period (12 months). The 12 month period will begin on the on the last day of pregnancy and end on the last day of the month in which the 365th day occurs. The new provisions also expand full scope coverage to individuals in restricted or limited scope Medi-Cal programs.
Aid Codes
Beginning April 1, 2022, a pregnant individual who gives birth will be granted a 365 day postpartum period and will remain in their full scope aid code. Individuals in a restricted or limited scope aid code will transition to a full scope aid code when their 365 day postpartum period is established on the last day of pregnancy.
Aid code 76 should not be granted concurrently with any full scope MAGI/Non-MAGI aid code. If the individual loses the full scope MAGI/Non-MAGI aid code, aid code 76 should be granted to continue full scope coverage for the remainder of the 365 day postpartum period. Aid code 76 should be granted concurrently with any restricted or limited scope aid code to grant full scope coverage for the 365 day postpartum period.
Retroactive Eligibility
Individuals applying for Medi-Cal in April 2022 can request retroactive coverage for any of the three previous months in 2022 (January, February, March). If found eligible for retroactive Medi-Cal and their pregnancy ended in any of the three previous months, the individual must have their 365 day postpartum period established from last day of their pregnancy.
Medi-Cal Redetermination After April 2022
If the individual later informs the county through the annual Medi-Cal Redetermination process and the individual did not have their 365 day postpartum period previously established, the individual must have their 365 day postpartum period established from the last day of their pregnancy
Allowable Reasons to Discontinue During the 365 Day Postpartum Period
There are only five allowable reasons to discontinue during the 365 day continuous eligibility period for the postpartum individual.
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Deceased
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Loss of California Residency
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Client Request
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Receipt of Social Security Supplemental income (SSI)
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Eligible for CalWORKS
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